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Antimicrobial Agents and Chemotherapy, October 2009, p. 4069-4079, Vol. 53, No. 10
0066-4804/09/$08.00+0 doi:10.1128/AAC.00341-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis
Shuli Svetitsky,1
Leonard Leibovici,2 and
Mical Paul3*
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,1 Department of Medicine E, Rabin Medical Center, Beilinson Hospital, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,2 Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel3
Received 12 March 2009/ Returned for modification 6 April 2009/ Accepted 6 July 2009
Vancomycin and teicoplanin are the glycopeptides currently in use for the treatment of infections caused by invasive beta-lactam-resistant gram-positive organisms. We conducted a systematic review and meta-analysis of randomized controlled trials that have compared vancomycin and teicoplanin administered systemically for the treatment of suspected or proven infections. A comprehensive search of trials without year, language, or publication status restrictions was performed. The primary outcome was all-cause mortality. Two reviewers independently extracted the data. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled by using the fixed-effect model (RRs of >1 favor vancomycin). Twenty-four trials were included. All-cause mortality was similar overall (RR, 0.95; 95% CI, 0.74 to 1.21), and there was no significant heterogeneity. In trials that used adequate allocation concealment, the results favored teicoplanin (RR, 0.82; 95% CI, 0.63 to 1.06), while in trials with unknown methods or inadequate concealment, the results favored vancomycin (RR, 3.61; 95% CI, 1.27 to 10.30). The latter trials might have recruited more severely ill patients. No other variable affected the RRs for mortality, including the assessment of glycopeptides administered empirically or for proven infections, neutropenia, the participant's age, and drug dosing. There were no significant differences between teicoplanin and vancomycin with regard to clinical failure (RR, 0.92; 95% CI, 0.81 to 1.05), microbiological failure (RR, 1.24; 95% CI, 0.93 to 1.65), and other efficacy outcomes. Lower RRs (in favor of teicoplanin) for clinical failure were observed with a lower risk of bias and when treatment was initiated for infections caused by gram-positive organisms rather than empirically. Total adverse events (RR, 0.61; 95% CI, 0.50 to 0.74), nephrotoxicity (RR, 0.44; 95% CI, 0.32 to 0.61), and red man syndrome were significantly less frequent with teicoplanin. Teicoplanin is not inferior to vancomycin with regard to efficacy and is associated with a lower adverse event rate than vancomycin.
* Corresponding author. Mailing address: Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel. Phone: 972-3-9377512. Fax: 972-3-9377513. E-mail: paulm{at}post.tau.ac.il.
Published ahead of print on 13 July 2009.
Antimicrobial Agents and Chemotherapy, October 2009, p. 4069-4079, Vol. 53, No. 10
0066-4804/09/$08.00+0 doi:10.1128/AAC.00341-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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